Community Partners Materials Request Form

Our Babies: Safe & Sound materials are available to community partners for distribution to families and caregivers in West Virginia. Please complete the following form to request copies of free campaign materials. 


Materials will be shipped to you via UPS.  (We cannot ship to Post Office Boxes.)


Copies are also available for download on the Resources page.  All materials are compatible with each other in messaging, color and design. The number of copies you may order depends on how many families you want to reach. Thank you!



    I would like to order the following:
(Select all that apply)
 		 Quantity Requested


   Say Yes to Safe Sleep Poster   11x17 inch colorful posters, primarily for display at your program sites & offices and in the community.
 


   Say Yes to Safe Sleep Brochure   Size 8.5 x11 inch tri-fold brochure, primarily for (1) use by staff when visiting expectant parents and families/caregivers of infants under the age of one, (2) distribution at program sites, and (3) distribution at community events.  


   Say Yes to Safe Sleep Pledge Form

  A pledge card for new parents and other caregivers to sign expressing their commitment to have their baby sleep safely.  


   Keep Your Cool Brochure – Targeted to males   8.5x11 inch tri-fold, targeted to males, primarily for (1) use by staff when visiting expectant parents and families/caregivers of infants under the age of one, (2) distribution at program sites, and (3) distribution at community events.  


   Keep Your Cool Brochure – Targeted to Moms   New in 2011. 8.5x11 inch tri-fold brochure, especially for moms of infants. Primarily for (1) use by staff when visiting expectant parents and families/caregivers of infants under the age of one, (2) distribution at program sites, and (3) distribution at local events.  
   Keep Your Cool Posters
  Choose from the following 4 different 11x17 inch posters featuring male fathers of infants “chilling” when baby cries – to prevent Shaken Baby Syndrome. Primarily for display at your program sites & offices and in the community.   
     


  
      "Meet Greg" "Meet Ben" "Meet Tony"
"Meet Jeff"
  
     Quantity

Quantity
Quantity

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   Our Babies: Safe & Sound DVD  

DVD contains 5 tools for educational purposes with families involved in your program and the general public:

  • 5 minute video of parents and a grandparent creating a safe sleep environment for baby
  • 30 and 60 second PSAs about Say Yes to Safe Sleep
  • 30 and 60 second PSAs about Keep Your Cool

 


   Safe & Sound Erasable Whiteboard   8x5 inch erasable white board refrigerator magnet with magnetic marker.  Serves as a ready reminder to reinforce campaign messages. Limited to one per family.  


   Community Partner Resource Guide
- Updated in
Oct. 2011
  Detailed guide that makes it easy for program staff to present Say Yes to Safe Sleep and Keep Your Cool messages to your families and community. Limit of 1 per staff person who works directly with targeted families.  

Contact Information
  Name of Partner Organization




 
 Contact Person



 
 Shipping Address
No P.O. Boxes please



 
 City / Town
WV orders only
, WV


 
 Zip


 
 Email Address
Address Must be valid



 
 Phone Number
XXX-XXX-XXXX


 
    
 Please note your program's site location(s).
If more than one site, please list individually.


 
 Number of program staff working with expectant parents / parents / caregivers of infants under age 1 at each site.


 
 Estimated number of families with infants under age 1 to be served at each site within the next 12 months.


 
 Comments or questions:


 
    
  
       		 





This program is being presented with financial assistance as a grant to the TEAM for West Virginia

Children from the WV Department of Health and Human Resources.